Opioids Methadone miserableness vs short acting opiates...

[frogman84]

Hey guys,

I have been reading all day about various countries' policies on opiate addiction treatment and am starting to feel there is some slow progress being made (mainly with the heroin trials).

That is not entirely the main point of this thread, though.

What started to come to me today was a few thoughts about the futures of those that like to/need to/will use opiates regularly for a lot of their adult lives.

Are long acting opiates just setting us up for a long period of maintained miserableness? And will shorter acting opiates (in constant supply) potentially allow a slightly better quality of life for the long term user?

Even though they are good on paper, having a long acting opiate in your system stops the regular ups and downs (of opiate saturation in the brain).

With constant saturation, every time a person tries to get high on methadone (which tell me is not almost inevitable) their overall saturation is bumped up by a significant amount, for a significant amount of time - leading to more upregulation of receptors (less chance to get high when still saturated and greater addiction).

Constantly using shorter acting opiates might allow the very start of withdrawal to set in quite regularly (allowing some receptor down regulation), while the user is not really in any significant discomfort?

Then by the next time the person wants to use their short acting opiate, they will more likely feel a measurable bit of enjoyment (perhaps not high but at least happy enough), because they have had less up regulation than had they been using long acting drugs.

Is it more hypothetically plausible that you could maintain a better quality of life on shorter acting opiates in constant supply, than by longer acting opiates in sparser supply?

This is probably common theory for those knowledgeable in this area, but it just dawned on me today.

Anyonne have experience/thoughts?

I find that when i use morphine alone quite regularly i feel fairly good, and if i wait a little while between doses (12 hours or so) i often don't have to sky rocket my dose to feel fine

 

[daddict]

This sounds good on paper, however ... many users will not be able consume their opies at a specific time (waiting for WDs to kick in, etc). They will just redose at the first sign of a withdrawal, thus escalating their tolerance continually.

Short term it is possible, but on the long run you would find yourself making exceptions to the rule. A bad day and you fall into "I would dose just once - it can't be that bad, sure .. ".

Long acting opiates are a pain in the ass to quit though, switching temporarily to a short acting opiate is the best option, IMHO.

 

[debaser]

In German speaking Cantons of Switzerland, they have heroin programs for the hardcore opiophiles. The thing is they have to go four times a day to the center to get their shot, and their driver's license is confiscated.

Anyway they can't have heroin takehomes, they have to be supervised by medical staff to have their dose.

edit: oh, I wanted to add, it's of course 98% pure liquid heroin and they inject it (for the record, this heroin is made in France and then sold to Switzerland).

 

[Tchort]

A significant portion of opioid addicts who seek treatment (statistically around 25%) will find all available treatments (Methadone, Buprenorphine, Clonidine, abstinence-only, etc) unacceptable, and will be unable to finish any of them successfully.

Theres a good bit of evidence that the Dutch, German and British models are far more successful at treating all opioid addicts who sign up for treatment.

Extended-release oral Morphine (Germany), combination of oral or IV Diamorphine with low dose oral Methadone (Netherlands), etc have better side effect profiles in general than high dose MMT. Studies into Hydromorphone subcutaneous pellet depot's, IV Hydromorphone, IV Morphine, oral Dextromoramide combined with low dose oral Methadone, IV Diamorphine, etc have all had similar results.

The British model, which technically allows for prescription of any opioid or combination of prescription drugs to treat opioid addiction, sounds the best to me. If you read between the lines in every single study, one thing is clear:

Limiting treatment options and availability (by overregulating, i.e. only allowing designated clinics or specially licensed doctors to prescribe certain pharmacotherapies) leads to poor success rates, poor patient retention, and poor patient acceptance of treatment modalities.

Everything should be on the table as an option, so that no individual addict falls through the cracks. I have no doubt that retention rates, patient acceptance and overall success rates would increase dramatically if any doctor or medical facility could treat opioid addicts with any modality or prescription drug.

On the question of short acting vs long acting opioids, there are distinct differences in patient acceptance (meaning how they feel). Methadone's NMDA antagonism and high volume of diffusion leads to a very unemotional, dissociated feeling that stays with many MMT patients constantly. This isn't present with someone on oral DHC or oral Morphine or oral Hydromorphone maintanence etc.

 

[frogman84]

Thanks Tchort, that was great information.

I have been seeing some serious talk of success in the less restrictive programs. It seems in these countries (mainly europe) they have really taken a great deal of time working on the users' lives, rather than thinking they have to just "cure them of using drugs".

I had missed the technicality of Methadone working on different receptors in addition to the ones acted on by simple morphine/heroin, and that definitely adds another thing to consider when looking at treatments.

Hypothetically speaking, if one were to be allowed to use regular morphine, in its short acting form, say two times a day, do you think there could be any possible advantages to this over say extended release morphine? AS FAR AS TOLERANCE IS CONCERNED.

Extended release options of morphine/other opioids are being looked at fairly consistently from a maintenance point of view because of the logistics of supply from chemists etc (only wanting to dose once a day).

As you say with the British system of "any drug for any illness", it may be possible to have constant supply of regular old morphine.

I wonder when it came down to tolerance, letting yourself ride the up and down of withdrawal each day, without too much discomfort, could be a beneficial thing in the long run.

I also understand the "But people will just be tempted to use it all at once" argument, but let's just forget that and think hypothetically

 

[daddict]

I am all in for a diacetylmorphine, morphine, whatever other short acting opioids.

I was just pointing the fact that such programs are not a solution for everyone. For people that still manage to have an active life, going to a clinic 4 times a day is not an option. Hell, I was on methadone for 10 years and going to my doc once a month was still a burden. But it is better than going to a clinic daily.

Best option would be to give people the choice to chose the treatment that best suits them.

I happen to leave close to those countries, and there is a big irrational fear that junkies will divert their H doses and sell them on the streets. This is total bullshit - I don't know many junkies that would sell their pure diacetylmorphine on the street. I certainly wont.

 

[SZodiac]

It's done in a supervised clinic environment. There is little possibility of any being diverted. Initial trials have been quite possitive. The drivers licence thing is a bit harsh but I suppose there is always a trade off. Methadone patients drive?

 

[debaser]

^ The swiss heroin patients are given some methadone for their evening and the night. But yes, there's zero possibility for heroin to be stolen as it is drastically controled by the medical staff.